Pastoral care is "that aspect of the ministry of the Church which is concerned with the well-being of
the individual and of the community in general." 2 It is clear that the impact of multiple traumas from
the COVID-19 pandemic creates a major challenge for pastoral care. The purpose of this publication
is to enable faith leaders to get some rapid and concise orientation on the issues of population and
community trauma, resilience, self-care and coping during and beyond the pandemic, so they can
consider strategies both for their congregations and the wider community.
This briefing seeks to provide some frameworks for response to the needs of:
1. Populations and local communities, because there will be multiple and differential impacts
on various sub-populations both by life course stage and by identity, as well as
socioeconomic status. Impacts are multiple, from losing loved, to losing jobs, to having
essential treatment delayed. All of these can be traumatic.
2. Faith communities, because as the pandemic goes on, and we are now beyond 18 months of
response, the risks of compassion fatigue, burnout and traumatic stress to congregations
increase. Psychological injury to those who are involved in 'frontline' ministry, both as
ministers or as medical and care workers, may be worse than in other parts of the
population because the combination of enduring stress and their own motivation to keep
serving their populations may result in their feeling unwilling or unable to seek help.
This briefing is set within the context of public mental health, which means it intentionally seeks to
consider what can be done at population level (e.g. whole church or workplace), and group level, not
just individual level. The right kind of action aimed at populations is just as important as action
aimed at individuals and should be seen as
complementary. This is especially so where there
are resources and capabilities which churches can
bring to bear for their whole membership, and
which can help them respond to trauma and
become resilient. In this sense, a populationhealth approach sits well with the idea of the Church as a community where healing can occur
This document was produced for a Webinar for the Association of Directors of Public Health (ADHP www.adph.org.uk ) on 27th April 2017 in partnership with Public Health England (PHE www.gov.uk/phe) Hertfordshire County Council (www.hertfordshire.gov.uk) and the Health Psychology in Public Health Network (HPPHN www.hppn.org.uk ).
The concept of empowerment is of increasing interest to researchers, practitioners and citizens concerned about mental health issues. In some respects, empowerment is a new buzzword. As Edelman (1977) has noted in relation to language and the politics of human services, sometimes new language is used to describe the same old practices. Others believe that empowerment language can actually lead to raised awareness (Rappaport, 1986). Regardless, a growing number of people are searching to understand the meaning of empowerment and ways it can be used to change their settings and lives. Empowerment can begin to be understood by examining the concepts of power and powerlessness (Moscovitch and Drover, 1981). Power is defined by the Cornell Empowerment Group as the "capacity of some persons and organizations to produce intended, foreseen and unforeseen effects on others" (Cornell Empowerment Group, 1989, p.2).
There are many sources of power. Personality, property/wealth, and influential organizations have been identified by Galbraith (1983) as critical sources of power in the last part of this century. Others have pointed out that the class-dominated nature of our society means that a small number of people have vast economic or political power, while the majority have little or none (Moscovitch & Drover, 1981) At the individual level, powerlessness can be seen as the expectation of the person that his/her own actions will be ineffective in influencing the outcome of life events (Keiffer, 1984). Lerner (1986) makes a distinction between real and surplus powerlessness. Real powerlessness results from economic inequities and oppressive control exercised by systems and other people. Surplus powerlessness, on the other hand, is an internalized belief that change cannot occur, a belief which results in apathy and an unwillingness of the person to struggle for more control and influence.
Powerlessness has, over the years, come to be viewed as an objective phenomenon, where people with little or no political and economic power lack the means to gain greater control and resources in their lives (Albee, 1981). As an illustration of powerlessness, Asch (1986) has noted that generally people with disabilities;
A critical comparison of the strengths and limitations of the pyschological a...GERATEC
The phrase “Understanding Dementia” is perhaps the ultimate oxymoron. For how can we even begin to “understand” something of which we know neither the cause nor the cure? In his introduction to Al Power’s book “Dementia beyond drugs” (Power, 2011), Bill Thomas, founder of The Eden Alternative says: “Conventional wisdom, if you can call it that, holds that dementia represents a peculiar, deadly, and completely irredeemable kind of decline.” (p.ix). A phenomenon that has been around as long as human beings themselves have been around, dementia presents an existential crisis to humanity in that it threatens everything that most people aim for – superficial or not – in living what Socrates described as a long, good life. In Jewish tradition it is customary to wish someone a long life when a relative passes away. Is this a good, happy wish or is it a curse when someone is diagnosed with Dementia every four seconds in the world? (World Health Organization, 2012)
The Psychological and the Gerontological approaches constitute an expansion on the purely biomedical perspective of the disease, exploring the impact that dementia has on the individual living with it, as well as the impact that it has on the broader community. It is argued in this assignment that while Psychology and Gerontology have expanded on the narrow viewpoints of the biomedical approach, the heterogeneous nature of the manifestations of dementia, especially in the Developing World where research is not on the political agenda, leaves the world none the wiser in how to deal with this epidemic.
CULTURAL FAMILY THERAPY: The Theory and Practice of Cultural Psychiatry with ...Université de Montréal
Society for the Study of Psychiatry and Culture
“Transforming Policy and Practice for
Culturally Competent Mental Health Care”
37th Annual Meeting
Minneapolis, MN – May 5-7, 2016
CULTURAL FAMILY THERAPY:
The Theory and Practice of Cultural Psychiatry with Families
Vincenzo Di Nicola, MD, PhD
Université de Montréal
and
Steven J. Wolin, MD
George Washington University
This interactive workshop presents Cultural Family Therapy (CFT), a synthesis of family therapy and cultural psychiatry based on Di Nicola’s book, A Stranger in the Family: Culture, Families, and Therapy (1997).
Three key processes for CFT will be demonstrated:
1) Cultural coherence: Each family coheres as and maintains it own culture, reflecting deep parallels between the functions of the family and culture, so that family culture supersedes the notion of family system;
2) Cultural transmission: Each family is the bearer of the larger culture(s) it is embedded in;
3) Cultural adaptation: CFT’s unique mission is to facilitate cultural adaptation for families undergoing culture change.
These processes will be illustrated with case examples.
In Part 2, participants will divide into two groups for discussion of CFT theory and practice, illustrated by two family cases in treatment with Wolin (a couple in continuous conflict whose battle concerns which family of origin will rule current family life) and Di Nicola (a young adult of mixed heritage whose core identity, sense of belonging, and symptomatic distress are in constant flux). Participants will apply the key CFT processes to these cases.
Part III will conclude by reconvening the participants for an interactive discussion, with a focus on applying CFT treatment strategies to their own clinical work with families undergoing culture change.
Learning objectives for this workshop are:
1. Identify three key processes that CFT employs to characterize today’s family and understand their functions in creating a unique culture for its members.
2. Formulate a clinical role for the family and cultural psychiatrist by specifying three clinical tools for conducting CFT with families undergoing culture change.
References:
Di Nicola, Vincenzo. A Stranger in the Family: Culture, Families, and Therapy. New York & London: W.W. Norton & Co., 1997.
Di Nicola, Vincenzo. Family, psychosocial, and cultural determinants of health. In: Sorel, Eliot, ed., 21st Century Global Mental Health. Burlington, MA: Jones & Bartlett Learning, 2012, pp. 119-150.
Pastoral care is "that aspect of the ministry of the Church which is concerned with the well-being of
the individual and of the community in general." 2 It is clear that the impact of multiple traumas from
the COVID-19 pandemic creates a major challenge for pastoral care. The purpose of this publication
is to enable faith leaders to get some rapid and concise orientation on the issues of population and
community trauma, resilience, self-care and coping during and beyond the pandemic, so they can
consider strategies both for their congregations and the wider community.
This briefing seeks to provide some frameworks for response to the needs of:
1. Populations and local communities, because there will be multiple and differential impacts
on various sub-populations both by life course stage and by identity, as well as
socioeconomic status. Impacts are multiple, from losing loved, to losing jobs, to having
essential treatment delayed. All of these can be traumatic.
2. Faith communities, because as the pandemic goes on, and we are now beyond 18 months of
response, the risks of compassion fatigue, burnout and traumatic stress to congregations
increase. Psychological injury to those who are involved in 'frontline' ministry, both as
ministers or as medical and care workers, may be worse than in other parts of the
population because the combination of enduring stress and their own motivation to keep
serving their populations may result in their feeling unwilling or unable to seek help.
This briefing is set within the context of public mental health, which means it intentionally seeks to
consider what can be done at population level (e.g. whole church or workplace), and group level, not
just individual level. The right kind of action aimed at populations is just as important as action
aimed at individuals and should be seen as
complementary. This is especially so where there
are resources and capabilities which churches can
bring to bear for their whole membership, and
which can help them respond to trauma and
become resilient. In this sense, a populationhealth approach sits well with the idea of the Church as a community where healing can occur
This document was produced for a Webinar for the Association of Directors of Public Health (ADHP www.adph.org.uk ) on 27th April 2017 in partnership with Public Health England (PHE www.gov.uk/phe) Hertfordshire County Council (www.hertfordshire.gov.uk) and the Health Psychology in Public Health Network (HPPHN www.hppn.org.uk ).
The concept of empowerment is of increasing interest to researchers, practitioners and citizens concerned about mental health issues. In some respects, empowerment is a new buzzword. As Edelman (1977) has noted in relation to language and the politics of human services, sometimes new language is used to describe the same old practices. Others believe that empowerment language can actually lead to raised awareness (Rappaport, 1986). Regardless, a growing number of people are searching to understand the meaning of empowerment and ways it can be used to change their settings and lives. Empowerment can begin to be understood by examining the concepts of power and powerlessness (Moscovitch and Drover, 1981). Power is defined by the Cornell Empowerment Group as the "capacity of some persons and organizations to produce intended, foreseen and unforeseen effects on others" (Cornell Empowerment Group, 1989, p.2).
There are many sources of power. Personality, property/wealth, and influential organizations have been identified by Galbraith (1983) as critical sources of power in the last part of this century. Others have pointed out that the class-dominated nature of our society means that a small number of people have vast economic or political power, while the majority have little or none (Moscovitch & Drover, 1981) At the individual level, powerlessness can be seen as the expectation of the person that his/her own actions will be ineffective in influencing the outcome of life events (Keiffer, 1984). Lerner (1986) makes a distinction between real and surplus powerlessness. Real powerlessness results from economic inequities and oppressive control exercised by systems and other people. Surplus powerlessness, on the other hand, is an internalized belief that change cannot occur, a belief which results in apathy and an unwillingness of the person to struggle for more control and influence.
Powerlessness has, over the years, come to be viewed as an objective phenomenon, where people with little or no political and economic power lack the means to gain greater control and resources in their lives (Albee, 1981). As an illustration of powerlessness, Asch (1986) has noted that generally people with disabilities;
A critical comparison of the strengths and limitations of the pyschological a...GERATEC
The phrase “Understanding Dementia” is perhaps the ultimate oxymoron. For how can we even begin to “understand” something of which we know neither the cause nor the cure? In his introduction to Al Power’s book “Dementia beyond drugs” (Power, 2011), Bill Thomas, founder of The Eden Alternative says: “Conventional wisdom, if you can call it that, holds that dementia represents a peculiar, deadly, and completely irredeemable kind of decline.” (p.ix). A phenomenon that has been around as long as human beings themselves have been around, dementia presents an existential crisis to humanity in that it threatens everything that most people aim for – superficial or not – in living what Socrates described as a long, good life. In Jewish tradition it is customary to wish someone a long life when a relative passes away. Is this a good, happy wish or is it a curse when someone is diagnosed with Dementia every four seconds in the world? (World Health Organization, 2012)
The Psychological and the Gerontological approaches constitute an expansion on the purely biomedical perspective of the disease, exploring the impact that dementia has on the individual living with it, as well as the impact that it has on the broader community. It is argued in this assignment that while Psychology and Gerontology have expanded on the narrow viewpoints of the biomedical approach, the heterogeneous nature of the manifestations of dementia, especially in the Developing World where research is not on the political agenda, leaves the world none the wiser in how to deal with this epidemic.
CULTURAL FAMILY THERAPY: The Theory and Practice of Cultural Psychiatry with ...Université de Montréal
Society for the Study of Psychiatry and Culture
“Transforming Policy and Practice for
Culturally Competent Mental Health Care”
37th Annual Meeting
Minneapolis, MN – May 5-7, 2016
CULTURAL FAMILY THERAPY:
The Theory and Practice of Cultural Psychiatry with Families
Vincenzo Di Nicola, MD, PhD
Université de Montréal
and
Steven J. Wolin, MD
George Washington University
This interactive workshop presents Cultural Family Therapy (CFT), a synthesis of family therapy and cultural psychiatry based on Di Nicola’s book, A Stranger in the Family: Culture, Families, and Therapy (1997).
Three key processes for CFT will be demonstrated:
1) Cultural coherence: Each family coheres as and maintains it own culture, reflecting deep parallels between the functions of the family and culture, so that family culture supersedes the notion of family system;
2) Cultural transmission: Each family is the bearer of the larger culture(s) it is embedded in;
3) Cultural adaptation: CFT’s unique mission is to facilitate cultural adaptation for families undergoing culture change.
These processes will be illustrated with case examples.
In Part 2, participants will divide into two groups for discussion of CFT theory and practice, illustrated by two family cases in treatment with Wolin (a couple in continuous conflict whose battle concerns which family of origin will rule current family life) and Di Nicola (a young adult of mixed heritage whose core identity, sense of belonging, and symptomatic distress are in constant flux). Participants will apply the key CFT processes to these cases.
Part III will conclude by reconvening the participants for an interactive discussion, with a focus on applying CFT treatment strategies to their own clinical work with families undergoing culture change.
Learning objectives for this workshop are:
1. Identify three key processes that CFT employs to characterize today’s family and understand their functions in creating a unique culture for its members.
2. Formulate a clinical role for the family and cultural psychiatrist by specifying three clinical tools for conducting CFT with families undergoing culture change.
References:
Di Nicola, Vincenzo. A Stranger in the Family: Culture, Families, and Therapy. New York & London: W.W. Norton & Co., 1997.
Di Nicola, Vincenzo. Family, psychosocial, and cultural determinants of health. In: Sorel, Eliot, ed., 21st Century Global Mental Health. Burlington, MA: Jones & Bartlett Learning, 2012, pp. 119-150.
Caring for a vulnerable person should be a noble calling, inspired by love and affection for the individual and sustained by the support of a caring community. The reality of life as a Carer for most people in South Africa cannot be further removed from this ideal.
A critical consideration of the potential of design and technology for the ca...GERATEC
Florence Nightingale gives some of the first words of advice on design in her “Notes on Nursing” - “But the fewer passages there are in a hospital the better”, referring to the fact that hospital design can impact the need for fresh air, that in her opinion is essential to the healing process (Nightingale, F. 1860). In 1943 Maslow developed his hierarchy of needs, starting with the physical need to be safe and secure, above which is the need to be loved, connected and belong, followed by the higher needs of understanding, knowing and self-actualization. The relationship between the physical buildings/environment and the impact on quality of life of the people living with dementia is the focus of this assignment.
The World Health Organization Quality of Life Assessment Group (1998) includes the physical environment as one of the dimensions of the quality of life. The quality of life of people living with dementia has been in the spotlight over the past years, and Ready and Ott (2003) did a review of the measurement tools, pointing out the differences and complexities of trying to determine exactly what constitutes quality of life for people living with dementia. The transactional interaction between people living with dementia, their care partners (both formal and informal), the new role of technology and the design of buildings and cities are explored in terms of the role it plays in constructing a new discourse for improvements in the quality of life of people living with dementia.
a brief synopsis of factors important in human interactions and behaviorism. Hungers dictate how one behaves in a social setting. These form some important cues in understanding a person in the relationship context; personal or business.
A critical discussion of the focus on the biomedical perspective in the preve...GERATEC
The biomedical focus on dementia brought the phenomena of what was considered a normal part of ageing into the medical and scientific field of interest (Bartlett, R and O’Connor, D. 2010). This perspective comes with a strong focus on neurodegenerative decline and deficits. Even though Alzheimer’s disease was around for more than 70 years since noted by Alois Alzheimer, it was only in the 1980’s that the “disease emerged as an illness category and policy issue” (Lyman, A. 1989). The Nun Study of David A. Snowdon, PhD, which started in 1991, brought a new perspective to the research into dementia. It was discovered during autopsies that people who have lived their lives without any signs of dementia, actually had amyloid plaques and tangles in their brains congruent to people living with dementia (Snowdon, D.A. 2003). Biomedical research is at this stage the primary focus of research into dementia, receiving most of the funding budget. According to an article in Therapy Today (July 2012) in the UK alone, £66 million will be allocated to dementia research by 2015, of which only £13 million is earmarked for social science research. In the WHO report on Dementia, Daviglus M.L. et al of the US National Institutes of Health state that “firm conclusions cannot be drawn about the association of any modifiable risk factor with cognitive decline of Alzheimer disease”.
The importance of the research findings of the biomedical model cannot be underestimated. However, considering the facts that t this point there seems to be nothing that can prevent nor cure Dementia, I am of the opinion that more research and funding should focused on creating a life worth living for people who live with dementia.
Medical Missions 1: Visual Model for Christian Relief and DevelopmentRobert Munson
A model developed from literary research associated with my dissertation regarding the use of medical missions for long-ministry of churches in the Philippines. I believe that this particular model is general enough to be of value in other contexts of Christian ministry.
Mental Health and Emotional Wellbeing in Ireland 2019Amarach Research
A survey of the Irish population about the sources of mental health and wellbeing, drawing on the Human Givens framework in relation to psychological needs and resources.
Medical Missions 3: Changing Priorities in HistoryRobert Munson
This article looks at change of priorities and practices in mission work based on the range of valid mission practices and changes in the human condition in time. This article seeks to show that development of missions priorities and practices is a creative process, rather than discovery of “one true method.” Medical missions is used as an example case to demonstrate that there are many forms of ministries that may be valid, and many changes in the human condition over time that effects proper prioritization and best practices.
Caring for a family member with dementia is fraught with burden and stress: A...GERATEC
The title “Caregiving for a family member with dementia is fraught with burden and stress” elicits more questions than answers. Who is this caregiver – husband or wife, son or daughter, second husband or wife, stepson or –daughter, daughter- or son-in-law, grandchild – a list with endless variations. Would the experience be different when caring for a mother to that of caring for a father, husband or wife, brother, uncle, aunt, cousin, and nephew? Can the term “caregiver” be considered a singular entity with a singular emotional experience? What is the role of - amongst others - culture, ethnicity, gender, sexual orientation, language, religion, age, personality, social environment and education? What role does the type of dementia of the care recipient play? Do all people deal with burden and stress in the same way, and if not, why not? What constitutes burden and stress, and how are these defined within the heterogeneous environment of caregiving?
It is often said, “If you have met one person with dementia, you have met one person with dementia”. The same might very well apply to the family caregiver. Nolan et al (2002) refer to Dilworth-Anderson and Montgomery & Williams (2001) when saying that “In essence the message is clear – caregiving can only be fully appreciated and adequately supported in its appropriate context”.
This is a summary of a journal article that was one of the first to advocate for the implementation of the Recovery Model in mental health care. You may seek the full text at your library or search online for the article as a pdf.
Social Psychiatry Comes of Age - Inaugural Column in Psychiatric TimesUniversité de Montréal
In this inaugural column on “Second Thoughts… About Psychiatry, Psychology, and Psychotherapy,” I want to express second thoughts about my profession in a warm and constructive way.
https://www.psychiatrictimes.com/view/social-psychiatry-comes-of-age
Caring for a vulnerable person should be a noble calling, inspired by love and affection for the individual and sustained by the support of a caring community. The reality of life as a Carer for most people in South Africa cannot be further removed from this ideal.
A critical consideration of the potential of design and technology for the ca...GERATEC
Florence Nightingale gives some of the first words of advice on design in her “Notes on Nursing” - “But the fewer passages there are in a hospital the better”, referring to the fact that hospital design can impact the need for fresh air, that in her opinion is essential to the healing process (Nightingale, F. 1860). In 1943 Maslow developed his hierarchy of needs, starting with the physical need to be safe and secure, above which is the need to be loved, connected and belong, followed by the higher needs of understanding, knowing and self-actualization. The relationship between the physical buildings/environment and the impact on quality of life of the people living with dementia is the focus of this assignment.
The World Health Organization Quality of Life Assessment Group (1998) includes the physical environment as one of the dimensions of the quality of life. The quality of life of people living with dementia has been in the spotlight over the past years, and Ready and Ott (2003) did a review of the measurement tools, pointing out the differences and complexities of trying to determine exactly what constitutes quality of life for people living with dementia. The transactional interaction between people living with dementia, their care partners (both formal and informal), the new role of technology and the design of buildings and cities are explored in terms of the role it plays in constructing a new discourse for improvements in the quality of life of people living with dementia.
a brief synopsis of factors important in human interactions and behaviorism. Hungers dictate how one behaves in a social setting. These form some important cues in understanding a person in the relationship context; personal or business.
A critical discussion of the focus on the biomedical perspective in the preve...GERATEC
The biomedical focus on dementia brought the phenomena of what was considered a normal part of ageing into the medical and scientific field of interest (Bartlett, R and O’Connor, D. 2010). This perspective comes with a strong focus on neurodegenerative decline and deficits. Even though Alzheimer’s disease was around for more than 70 years since noted by Alois Alzheimer, it was only in the 1980’s that the “disease emerged as an illness category and policy issue” (Lyman, A. 1989). The Nun Study of David A. Snowdon, PhD, which started in 1991, brought a new perspective to the research into dementia. It was discovered during autopsies that people who have lived their lives without any signs of dementia, actually had amyloid plaques and tangles in their brains congruent to people living with dementia (Snowdon, D.A. 2003). Biomedical research is at this stage the primary focus of research into dementia, receiving most of the funding budget. According to an article in Therapy Today (July 2012) in the UK alone, £66 million will be allocated to dementia research by 2015, of which only £13 million is earmarked for social science research. In the WHO report on Dementia, Daviglus M.L. et al of the US National Institutes of Health state that “firm conclusions cannot be drawn about the association of any modifiable risk factor with cognitive decline of Alzheimer disease”.
The importance of the research findings of the biomedical model cannot be underestimated. However, considering the facts that t this point there seems to be nothing that can prevent nor cure Dementia, I am of the opinion that more research and funding should focused on creating a life worth living for people who live with dementia.
Medical Missions 1: Visual Model for Christian Relief and DevelopmentRobert Munson
A model developed from literary research associated with my dissertation regarding the use of medical missions for long-ministry of churches in the Philippines. I believe that this particular model is general enough to be of value in other contexts of Christian ministry.
Mental Health and Emotional Wellbeing in Ireland 2019Amarach Research
A survey of the Irish population about the sources of mental health and wellbeing, drawing on the Human Givens framework in relation to psychological needs and resources.
Medical Missions 3: Changing Priorities in HistoryRobert Munson
This article looks at change of priorities and practices in mission work based on the range of valid mission practices and changes in the human condition in time. This article seeks to show that development of missions priorities and practices is a creative process, rather than discovery of “one true method.” Medical missions is used as an example case to demonstrate that there are many forms of ministries that may be valid, and many changes in the human condition over time that effects proper prioritization and best practices.
Caring for a family member with dementia is fraught with burden and stress: A...GERATEC
The title “Caregiving for a family member with dementia is fraught with burden and stress” elicits more questions than answers. Who is this caregiver – husband or wife, son or daughter, second husband or wife, stepson or –daughter, daughter- or son-in-law, grandchild – a list with endless variations. Would the experience be different when caring for a mother to that of caring for a father, husband or wife, brother, uncle, aunt, cousin, and nephew? Can the term “caregiver” be considered a singular entity with a singular emotional experience? What is the role of - amongst others - culture, ethnicity, gender, sexual orientation, language, religion, age, personality, social environment and education? What role does the type of dementia of the care recipient play? Do all people deal with burden and stress in the same way, and if not, why not? What constitutes burden and stress, and how are these defined within the heterogeneous environment of caregiving?
It is often said, “If you have met one person with dementia, you have met one person with dementia”. The same might very well apply to the family caregiver. Nolan et al (2002) refer to Dilworth-Anderson and Montgomery & Williams (2001) when saying that “In essence the message is clear – caregiving can only be fully appreciated and adequately supported in its appropriate context”.
This is a summary of a journal article that was one of the first to advocate for the implementation of the Recovery Model in mental health care. You may seek the full text at your library or search online for the article as a pdf.
Social Psychiatry Comes of Age - Inaugural Column in Psychiatric TimesUniversité de Montréal
In this inaugural column on “Second Thoughts… About Psychiatry, Psychology, and Psychotherapy,” I want to express second thoughts about my profession in a warm and constructive way.
https://www.psychiatrictimes.com/view/social-psychiatry-comes-of-age
SAINT FRANCIS DE SALES COLLEGE, AALO
DEPARTMENT OF SOCIOLOGY,
NATIONAL WEBINAR
ON
“MENTAL HEALTH AND WELL- BEING”
Sociological Perspectives on
Mental Health and Illness
Where is the Family in Global Mental Health? Di Nicola - Opening Plenary - SS...Université de Montréal
Title: Where Is the Family in Global Mental Health?
Presenter: Vincenzo Di Nicola, M.D., Ph.D.
Learning Objectives:
Audience participants will be able to:
(1) Articulate why a central role for families is needed for the effectiveness of clinical and research programs in Global Mental Health (GMH);
(2) Describe how health categories that focus solely on individuals can obscure awareness of relational, social, and cultural processes that contribute to health and illness.
Abstract:
From a family perspective, the Global Mental Health Movement appears as a regressive step to the usual Western health categories that focus on individuals as bearers of larger issues in the family, community, society and culture. These larger envelopes are addressed in the impersonal way of categories—e.g., child abuse, substance abuse, violence, and treatment gaps—rather than from the relational, social and cultural perspectives that define mental health and illness more fully, meaningfully, and realistically. These aspects of GMH may deepen the practitioners’ perception of public health and epidemiology and their international organizations as being removed from clinical concerns and from their meaningful relational contexts. Without such notions as attachment and belonging, ignoring the most significant of human relationships based on the family and community, GMH risks creating another disembodied field divorced from our lived experience as communal and relational beings.
References
Di Nicola, Vincenzo. A Stranger in the Family: Culture, Families, and Therapy. New York & London: W.W. Norton, 1997.
Di Nicola, Vincenzo. Letters to a Young Therapist: Relational Practices for the Coming Community. New York & Dresden: Atropos Press, 2011.
Di Nicola, Vincenzo. Family, psychosocial, and cultural determinants of health. In: Sorel, Eliot, ed., 21st Century Global Mental Health. Burlington, MA: Jones & Bartlett Learning, 2012, pp. 119-150.
Bio Sketch
Vincenzo Di Nicola, MPhil, MD, PhD, is a Child and Adolescent Psychiatrist who uses family, social and cultural perspectives to investigate children and families in disadvantaged contexts, both at home and abroad. He works with migrant children and families and the impacts of trauma. Di Nicola is the author of “A Stranger in the Family: Culture, Families, and Therapy” (1997), “Letters to a Young Therapist” (2011), and a forthcoming selection of his writing, “On the Threshold: Children, Families, and Culture Change,” edited and introduced by Armando Favazza, MD, MPH. Di Nicola is Chair of the APA Global Mental Health Caucus and Full Professor of Psychiatry at the University of Montreal.
Lesson 14 Consumer Movement Readings Video People Say I’.docxSHIVA101531
Lesson 14: Consumer Movement
Readings:
Video: “People Say I’m Crazy http://www.youtube.com/watch?v=VdzHl65XPYc
Campbell, J. (2005). The historical and philosophical development of peer-run support programs. In Clay, S., Schell, B., Corrigan, P. W., and R. O. Ralph (eds.) On Our Own Together: Peer Programs for People with Mental Illness. Nashville, TN: Vanderbilt Press. 17-64.
The President’s New Freedom Commission on Mental Health (March 5, 2003). “Summary Report of the Subcommittee on Consumer Issues:
Shifting to a Recovery-Based Continuum of Community Care.”
http://www.power2u.org/downloads/consumers_issues_summary.pdf
Introduction
Consumers of mental health services have sought to find their voice for a long while. As early as 1873, Mrs. E.P.W. (Elizabeth) Packard published her book entitled, Modern Persecution, or Insane Asylums Unveiled. Forcibly committed to a psychiatric institution by her husband, Mrs. Packard was an early advocate for establishing rights for patients with mental disorders, founding the Anti-Insane Asylum Society in Illinois (Chamberlin, 1990).
Other persons, however, were speaking out about the rights of patients with mental disorders, probably the most well-known of whom was Clifford Beers. As you may recall from Lesson 2, Beers founded the National Committee for Mental Hygiene, now called Mental Health America, in 1909. His important autobiography, A Mind That Found Itself, published in 1908 and still in print, chronicled his experiences with mental illness. He started the first outpatient mental health clinical in New Haven, Connecticut in 1913.
While these historical occurrences displayed an early preface to activism for persons who experienced mental illness, the modern consumer movement did not start until almost a century later.
Consumer/Survivor movement
The modern consumer/survivor movement is an outgrowth of the reorganization of the mental health system from the 1950’s through the 1970’s. This reorganization resulted from “deinstitutionalization, new psychotropic drug treatments, the widening legal conceptions of patients’ rights, and the intellectual critiques associate with the antipsychiatry movement” (Tomes, 2006, p. 722). The first consumer/survivor group was founded sometime during the late 60’s or early 70’s, and was called the Oregon Insane Liberation Front, taking its cue from other liberation movements that were prevalent during that time.
As we saw in Lesson 11, stigma has been a difficult problem for those with serious mental illness (SMI) to overcome. Green-Hennessy & Hennessy (2004) note that psychiatric symptoms are only some of the problems faced by persons with mental illness. Persons with mental illness also are feared and discriminated against by society, their rights are not valued and their opportunities limited, and “the mental health system . . . at times has undermined the very healing it attempts to promote” (Green-Hennessy & Hennessy (2004, p. 88). This ...
The job is just to read each individual peer post that I put there.docxarmitageclaire49
The job is just to read each individual peer post that I put there and respond to them with a response of 3-4 sentences long
Peer #1
For the Research Assignment, I have chosen to focus on an area of Healthcare that rarely gets the
attention it deserves Mental health. I
chose this topic because I am personally effected by it and so are many millions of Americans. Mental illness is also one of the leading causes of
death in our nation and one life is lost as a result of suicide, abuse or incarceration every 17mins in the United States. Mental illness has been my
area of focus throughout this program and the advocacy and participatory philosophy will be useful for the final project because it suggests that “
that research inquiry needs to be intertwined with politics and a political agenda” (Creswell, p.9). I do believe that mental health has a specific
agenda for a study and that there has been constant aim for reform in healthcare and mental health. This social issue is definitely pertinent right
now and topics that address it such as “empowerment, inequality, oppression, domination, suppression, and alienation” (Creswell, p.9), and are
really the focus of the study. The goal of this project for me, is to provide a voice to participants and give them the ability address the concerns that
will lead to reform.
According to Kemmis and Wilkinson (1998) this philosophy offers four key features of the advocacy/participatory framework of inquiry:
1. Participatory actions are focused on bringing about change, and at the end of this type of study, researchers create an action agenda for change.
2. It is focused on freeing individuals from societal constraints, which is why the study begins with an important issue currently in society.
3. It aims to create a political debate so that change will occur.
4. Since advocacy/participatory researchers engage participants as active contributors to the research, it is a collaborative experience.
Research Problem Statement
My Vision is to Provide members of the community with the opportunities and education needed to prevent death due to suicide, acts of self-harm
and the traumatic impact of mental illness. By promoting resilience, the enhancement of community resources, conflict resolution and support for
individuals, families and the communities of those who suffer with mental disorders, illness or have a sudden mental health crisis. The target
population includes all individuals within Chatham County, with unmet mental health needs. These individuals are currently not being served by
traditional methods due to financial, structural, and personal barriers including access and stigma. Untreated mental health issues of these
individuals put them at risk for exacerbation of physical health problems, suicide attempts, premature moves to long-term care se.
Delivering Micro-Credentials in Technical and Vocational Education and TrainingAG2 Design
Explore how micro-credentials are transforming Technical and Vocational Education and Training (TVET) with this comprehensive slide deck. Discover what micro-credentials are, their importance in TVET, the advantages they offer, and the insights from industry experts. Additionally, learn about the top software applications available for creating and managing micro-credentials. This presentation also includes valuable resources and a discussion on the future of these specialised certifications.
For more detailed information on delivering micro-credentials in TVET, visit this https://tvettrainer.com/delivering-micro-credentials-in-tvet/
A Strategic Approach: GenAI in EducationPeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
Read| The latest issue of The Challenger is here! We are thrilled to announce that our school paper has qualified for the NATIONAL SCHOOLS PRESS CONFERENCE (NSPC) 2024. Thank you for your unwavering support and trust. Dive into the stories that made us stand out!
Biological screening of herbal drugs: Introduction and Need for
Phyto-Pharmacological Screening, New Strategies for evaluating
Natural Products, In vitro evaluation techniques for Antioxidants, Antimicrobial and Anticancer drugs. In vivo evaluation techniques
for Anti-inflammatory, Antiulcer, Anticancer, Wound healing, Antidiabetic, Hepatoprotective, Cardio protective, Diuretics and
Antifertility, Toxicity studies as per OECD guidelines
How to Add Chatter in the odoo 17 ERP ModuleCeline George
In Odoo, the chatter is like a chat tool that helps you work together on records. You can leave notes and track things, making it easier to talk with your team and partners. Inside chatter, all communication history, activity, and changes will be displayed.
The simplified electron and muon model, Oscillating Spacetime: The Foundation...RitikBhardwaj56
Discover the Simplified Electron and Muon Model: A New Wave-Based Approach to Understanding Particles delves into a groundbreaking theory that presents electrons and muons as rotating soliton waves within oscillating spacetime. Geared towards students, researchers, and science buffs, this book breaks down complex ideas into simple explanations. It covers topics such as electron waves, temporal dynamics, and the implications of this model on particle physics. With clear illustrations and easy-to-follow explanations, readers will gain a new outlook on the universe's fundamental nature.
Safalta Digital marketing institute in Noida, provide complete applications that encompass a huge range of virtual advertising and marketing additives, which includes search engine optimization, virtual communication advertising, pay-per-click on marketing, content material advertising, internet analytics, and greater. These university courses are designed for students who possess a comprehensive understanding of virtual marketing strategies and attributes.Safalta Digital Marketing Institute in Noida is a first choice for young individuals or students who are looking to start their careers in the field of digital advertising. The institute gives specialized courses designed and certification.
for beginners, providing thorough training in areas such as SEO, digital communication marketing, and PPC training in Noida. After finishing the program, students receive the certifications recognised by top different universitie, setting a strong foundation for a successful career in digital marketing.
June 3, 2024 Anti-Semitism Letter Sent to MIT President Kornbluth and MIT Cor...Levi Shapiro
Letter from the Congress of the United States regarding Anti-Semitism sent June 3rd to MIT President Sally Kornbluth, MIT Corp Chair, Mark Gorenberg
Dear Dr. Kornbluth and Mr. Gorenberg,
The US House of Representatives is deeply concerned by ongoing and pervasive acts of antisemitic
harassment and intimidation at the Massachusetts Institute of Technology (MIT). Failing to act decisively to ensure a safe learning environment for all students would be a grave dereliction of your responsibilities as President of MIT and Chair of the MIT Corporation.
This Congress will not stand idly by and allow an environment hostile to Jewish students to persist. The House believes that your institution is in violation of Title VI of the Civil Rights Act, and the inability or
unwillingness to rectify this violation through action requires accountability.
Postsecondary education is a unique opportunity for students to learn and have their ideas and beliefs challenged. However, universities receiving hundreds of millions of federal funds annually have denied
students that opportunity and have been hijacked to become venues for the promotion of terrorism, antisemitic harassment and intimidation, unlawful encampments, and in some cases, assaults and riots.
The House of Representatives will not countenance the use of federal funds to indoctrinate students into hateful, antisemitic, anti-American supporters of terrorism. Investigations into campus antisemitism by the Committee on Education and the Workforce and the Committee on Ways and Means have been expanded into a Congress-wide probe across all relevant jurisdictions to address this national crisis. The undersigned Committees will conduct oversight into the use of federal funds at MIT and its learning environment under authorities granted to each Committee.
• The Committee on Education and the Workforce has been investigating your institution since December 7, 2023. The Committee has broad jurisdiction over postsecondary education, including its compliance with Title VI of the Civil Rights Act, campus safety concerns over disruptions to the learning environment, and the awarding of federal student aid under the Higher Education Act.
• The Committee on Oversight and Accountability is investigating the sources of funding and other support flowing to groups espousing pro-Hamas propaganda and engaged in antisemitic harassment and intimidation of students. The Committee on Oversight and Accountability is the principal oversight committee of the US House of Representatives and has broad authority to investigate “any matter” at “any time” under House Rule X.
• The Committee on Ways and Means has been investigating several universities since November 15, 2023, when the Committee held a hearing entitled From Ivory Towers to Dark Corners: Investigating the Nexus Between Antisemitism, Tax-Exempt Universities, and Terror Financing. The Committee followed the hearing with letters to those institutions on January 10, 202
MATATAG CURRICULUM: ASSESSING THE READINESS OF ELEM. PUBLIC SCHOOL TEACHERS I...NelTorrente
In this research, it concludes that while the readiness of teachers in Caloocan City to implement the MATATAG Curriculum is generally positive, targeted efforts in professional development, resource distribution, support networks, and comprehensive preparation can address the existing gaps and ensure successful curriculum implementation.
2. Many approaches of therapy basically focus on theMany approaches of therapy basically focus on the
individual who has already developed psychologicalindividual who has already developed psychological
problems.problems.
At the theoretical level, therapists have long acceptedAt the theoretical level, therapists have long accepted
the idea that all behavior (pathological or otherwise) isthe idea that all behavior (pathological or otherwise) is
a joint product of situational and personal factors.a joint product of situational and personal factors.
Yet in their day-to-day therapeutic efforts, theYet in their day-to-day therapeutic efforts, the
emphasis of clinicians was generally on one-to-oneemphasis of clinicians was generally on one-to-one
therapy of some sort.therapy of some sort.
A relatively newer approach, communityA relatively newer approach, community psychology,psychology,
shows great promise for addressing mental healthshows great promise for addressing mental health
problems.problems.
3. PRINCIPLES OF COMMUNITY PSYCHOLOGYPRINCIPLES OF COMMUNITY PSYCHOLOGY
What "causes" problems?What "causes" problems?
Problems develop due to an interaction over timeProblems develop due to an interaction over time
between the individual, social setting, and systems.between the individual, social setting, and systems.
How are problems defined?How are problems defined?
Problems can be defined at many levels, but particularProblems can be defined at many levels, but particular
emphasis is placed on analysis at the community andemphasis is placed on analysis at the community and
organization level.organization level.
Where is community psychology practiced?Where is community psychology practiced?
In the field or in the social context of interest.In the field or in the social context of interest.
4. How are services planned?How are services planned?
The needs and risks in a community areThe needs and risks in a community are
proactively assessed.proactively assessed.
What is the emphasis in communityWhat is the emphasis in community
psychology interventions?psychology interventions?
Prevention of problems rather than treatment ofPrevention of problems rather than treatment of
existing problems.existing problems.
Who is qualified to intervene?Who is qualified to intervene?
Interventions are often carried out through self-Interventions are often carried out through self-
help programs.help programs.
6. THE COMMUNITY PSYCHOLOGYTHE COMMUNITY PSYCHOLOGY
PERSPECTIVEPERSPECTIVE
Community psychology has been described asCommunity psychology has been described as
an approach to mental health that emphasizesan approach to mental health that emphasizes
the role of environmental forces in creating andthe role of environmental forces in creating and
alleviating problems (Zax & Specter, 1974).alleviating problems (Zax & Specter, 1974).
The major aspects of this perspective areThe major aspects of this perspective are
cultural relativity, diversity, and ecology (the fitcultural relativity, diversity, and ecology (the fit
between persons and the environment).between persons and the environment).
7. First, community psychologists should not beFirst, community psychologists should not be
concerned exclusively with inadequate environmentsconcerned exclusively with inadequate environments
or persons. Rather, they should direct their attention toor persons. Rather, they should direct their attention to
the fit between environments and persons-a fit thatthe fit between environments and persons-a fit that
may or may not be good.may or may not be good.
Second, the focus is on action directed toward theSecond, the focus is on action directed toward the
competencies of persons and environments rathercompetencies of persons and environments rather
than their deficits.than their deficits.
Third, the community psychologist is likely to believeThird, the community psychologist is likely to believe
that differences among people and communities arethat differences among people and communities are
desirable.desirable.
The community psychologist is not identified with aThe community psychologist is not identified with a
single social norm or value, but instead looks to thesingle social norm or value, but instead looks to the
promotion of diversity.promotion of diversity.
8. In Rappaport's (1977) view, three sets of concernsIn Rappaport's (1977) view, three sets of concerns
define the community psychology perspective:define the community psychology perspective:
Human resource developmentHuman resource development,, political activitypolitical activity,,
andand sciencescience..
In many ways, these are antagonistic elements.In many ways, these are antagonistic elements.
Political activists are often impatient and ridicule morePolitical activists are often impatient and ridicule more
traditional clinicians as bringing society too little tootraditional clinicians as bringing society too little too
late.late.
Clinicians, in turn, often criticize activists asClinicians, in turn, often criticize activists as
unprofessional and overly concerned with hawkingunprofessional and overly concerned with hawking
their own visions of the world.their own visions of the world.
The scientists, in turn are appalled by activists andThe scientists, in turn are appalled by activists and
clinicians alike; both are seen as shockingly willing toclinicians alike; both are seen as shockingly willing to
act on the basis of invalidated hunches and lack ofact on the basis of invalidated hunches and lack of
data or, worst of all, without a viable theory to guidedata or, worst of all, without a viable theory to guide
them.them.
9. In fact, true societal changes vis-a-vis mentalIn fact, true societal changes vis-a-vis mental
health will require the cooperation of each ofhealth will require the cooperation of each of
these "camps."these "camps."
Whatever else community psychology may be,Whatever else community psychology may be,
it is not a field that emphasizes an individualit is not a field that emphasizes an individual
disease or individual treatment model .disease or individual treatment model .
The focus is preventive rather than curative.The focus is preventive rather than curative.
Further, individuals and communityFurther, individuals and community
organizations are encouraged to take controlorganizations are encouraged to take control
of and master their own problems (viaof and master their own problems (via
empowerment) so that traditional professionalempowerment) so that traditional professional
intervention will not be necessary.intervention will not be necessary.
10. HISTORY AND CATALYZING EVENTSHISTORY AND CATALYZING EVENTS
In 1955, the U.S. Congress passed legislation creatingIn 1955, the U.S. Congress passed legislation creating
the joint Commission on Mental Health and Illness.the joint Commission on Mental Health and Illness.
Its report encouraged the development of aIts report encouraged the development of a
community mental health concept and urged acommunity mental health concept and urged a
reduction in the population of mental hospitals.reduction in the population of mental hospitals.
Based on the premise that psychological distress andBased on the premise that psychological distress and
the development of mental disorders were influencedthe development of mental disorders were influenced
by adverse environmental conditions, Presidentby adverse environmental conditions, President
Kennedy called for a "bold new approach" toKennedy called for a "bold new approach" to preventprevent
mental disorder.mental disorder.
Their aims were to promote the early detection ofTheir aims were to promote the early detection of
mental health problems, treat acute disorders, andmental health problems, treat acute disorders, and
establish comprehensive delivery systems of servicesestablish comprehensive delivery systems of services
that would prevent the "warehousing" of chronicthat would prevent the "warehousing" of chronic
patients in mental hospitals .patients in mental hospitals .
11. The American Psychological Association endorsed theThe American Psychological Association endorsed the
desirability of community residents' participating in alldesirability of community residents' participating in all
these decisions.these decisions.
A conference held in 1965 is regarded by many as theA conference held in 1965 is regarded by many as the
"official" birth of community psychology."official" birth of community psychology.
Shortly after this conference, the Division ofShortly after this conference, the Division of
Community Psychology was organized within theCommunity Psychology was organized within the
American Psychological Association.American Psychological Association.
SoonSoon The Community Mental Health JournalThe Community Mental Health Journal andand
thethe American Journal of Community PsychologyAmerican Journal of Community Psychology
began publication.began publication.
Courses in community psychology and programs ofCourses in community psychology and programs of
graduate training have been established, and theregraduate training have been established, and there
are even books now on the history of communityare even books now on the history of community
mental health.mental health.
12. Issues or concerns that have catalyzed theIssues or concerns that have catalyzed the
emergence of community psychology:emergence of community psychology:
TREATMENT FACILITIESTREATMENT FACILITIES
Although the mental hospital population in the UnitedAlthough the mental hospital population in the United
States peaked at about 500,000 in the mid-1950s,States peaked at about 500,000 in the mid-1950s,
socially oriented clinicians continued to press forsocially oriented clinicians continued to press for
alternatives to the costly, inefficient, and often largelyalternatives to the costly, inefficient, and often largely
custodial hospitalization of patients. Three factorscustodial hospitalization of patients. Three factors
combined at about this time to markedly reduce thecombined at about this time to markedly reduce the
population of mental hospitals:population of mental hospitals:
The advent of psychotropic medications,The advent of psychotropic medications,
A more liberal discharge philosophy,A more liberal discharge philosophy,
And better treatment in mental hospitals.And better treatment in mental hospitals.
13. A problem with many mental hospitals was their lackA problem with many mental hospitals was their lack
of trained therapists.of trained therapists.
Regarded by lay-persons as a realistic means forRegarded by lay-persons as a realistic means for
solving difficult emotional problems, hospitalizationsolving difficult emotional problems, hospitalization
itself often created nearly as many problems as ititself often created nearly as many problems as it
alleviated.alleviated.
Over the years, mental hospitals (particularly thoseOver the years, mental hospitals (particularly those
run by the states) too often became ware-houses orrun by the states) too often became ware-houses or
custodial bins.custodial bins.
Care was often marginal and sometimes downrightCare was often marginal and sometimes downright
inhumane. Professional staff was severely lacking ininhumane. Professional staff was severely lacking in
numbers and sometimes in quality.numbers and sometimes in quality.
Indeed, many still argue (and have demonstratedIndeed, many still argue (and have demonstrated
empirically) that hospitalization is not an especiallyempirically) that hospitalization is not an especially
effective treatment strategy.effective treatment strategy.
14. PERSONNEL SHORTAGEPERSONNEL SHORTAGE
Even as more clinical psychologists and psychiatristsEven as more clinical psychologists and psychiatrists
were trained; demands for their services outstrippedwere trained; demands for their services outstripped
their increase in numbers.their increase in numbers.
Many of the newcomers were entering privateMany of the newcomers were entering private
practice, and others were being diverted into teachingpractice, and others were being diverted into teaching
or research.or research.
A number of trends all seemed to coalesce to produceA number of trends all seemed to coalesce to produce
critical shortages of hospital and clinic personnel.critical shortages of hospital and clinic personnel.
To grapple with these shortages, it became imperativeTo grapple with these shortages, it became imperative
that new sources of personnel be sought, that morethat new sources of personnel be sought, that more
effective use be made of professional time, and thateffective use be made of professional time, and that
new models of coping with human problems benew models of coping with human problems be
developed.developed.
Albee (1959, 1968) predicted that it would be literallyAlbee (1959, 1968) predicted that it would be literally
impossible to train enough mental health professionalsimpossible to train enough mental health professionals
to meet existing and future needs, and recommendedto meet existing and future needs, and recommended
that prevention be pursued as a strategy.that prevention be pursued as a strategy.
15. QUESTIONS ABOUT PSYCHOTHERAPYQUESTIONS ABOUT PSYCHOTHERAPY
In the 1950s, people began to question not just theIn the 1950s, people began to question not just the
efficiency of psychotherapy but also its effectiveness.efficiency of psychotherapy but also its effectiveness.
Some began to wonder if it was not just intra psychicSome began to wonder if it was not just intra psychic
factors that created problems, but the interactionfactors that created problems, but the interaction
between person and society.between person and society.
At the same time, economic factors were pushingAt the same time, economic factors were pushing
therapy beyond the reach of the poor andtherapy beyond the reach of the poor and
disadvantaged.disadvantaged.
The relationship between mental illness and socialThe relationship between mental illness and social
class had been documented by researchers.class had been documented by researchers.
Now, it seemed, there was also a relationship betweenNow, it seemed, there was also a relationship between
social class and the availability of psychotherapy.social class and the availability of psychotherapy.
16. MEDICAL MODELS AND ROLESMEDICAL MODELS AND ROLES
We know the widespread role of the medicalWe know the widespread role of the medical
model and some of the dissatisfaction with it.model and some of the dissatisfaction with it.
The 1960s ushered in a climate in whichThe 1960s ushered in a climate in which
institutional prerogatives and traditionalistinstitutional prerogatives and traditionalist
beliefs came under attack.beliefs came under attack.
That climate produced listeners who were moreThat climate produced listeners who were more
willing to accept attacks on traditional viewswilling to accept attacks on traditional views
about mental illness.about mental illness.
All of this contributed to an increased tendencyAll of this contributed to an increased tendency
to look for the social-community antecedents ofto look for the social-community antecedents of
problems in lining, rather than internalproblems in lining, rather than internal
biological or psychological etiological agents.biological or psychological etiological agents.
17. The general activism of the 1960s also catalyzed theThe general activism of the 1960s also catalyzed the
long-standing discontent of many clinicians with a rolelong-standing discontent of many clinicians with a role
that relegated them to waiting passively for society'sthat relegated them to waiting passively for society's
casualties to walk in the door.casualties to walk in the door.
Would not an activist role that took mental healthWould not an activist role that took mental health
services to the people be more consonant with aservices to the people be more consonant with a
social-community model? If so, such a role would alsosocial-community model? If so, such a role would also
provide a measure of autonomy from the dominanceprovide a measure of autonomy from the dominance
of the medical profession.of the medical profession.
We must not overstate these developments, however.We must not overstate these developments, however.
After all a major current trend in clinical psychologyAfter all a major current trend in clinical psychology
has been a headlong rush into private practice.has been a headlong rush into private practice.
Such behavior is hardly a rejection of the medicalSuch behavior is hardly a rejection of the medical
model or an acceptance of the social-communitymodel or an acceptance of the social-community
approach.approach.
18. THE ENVIRONMENTTHE ENVIRONMENT
Another force that helped shape the communityAnother force that helped shape the community
psychology movement was a greater awareness of thepsychology movement was a greater awareness of the
importance of social and environmental factors inimportance of social and environmental factors in
determining people's behavior and problems.determining people's behavior and problems.
Poverty, discrimination, pollution, and crowding werePoverty, discrimination, pollution, and crowding were
being recognized as potent factors.being recognized as potent factors.
Providing people with choices and enhancing their well-Providing people with choices and enhancing their well-
being required that psychologists pay attention to thesebeing required that psychologists pay attention to these
factors that they go beyond a reflexive consideration offactors that they go beyond a reflexive consideration of
the early childhood determinants of people'sthe early childhood determinants of people's
personalities.personalities.
The emotional problems of large numbers of peopleThe emotional problems of large numbers of people
may be influenced by poverty, unemployment, jobmay be influenced by poverty, unemployment, job
discrimination, racism, diminished educationaldiscrimination, racism, diminished educational
opportunities, sexism, and other social factors.opportunities, sexism, and other social factors.
Such influences are hardly proposed by therapies thatSuch influences are hardly proposed by therapies that
seek answers in internal dynamics.seek answers in internal dynamics.
19. THE CONCEPT OF COMMUNITYTHE CONCEPT OF COMMUNITY
MENTAL HEALTHMENTAL HEALTH
The 1955 Joint Commission on Mental HealthThe 1955 Joint Commission on Mental Health
and Illness made several basicand Illness made several basic
recommendations that set the tone for therecommendations that set the tone for the
subsequent development of communitysubsequent development of community
psychology-a tone that still resonates in accordpsychology-a tone that still resonates in accord
with political and financial pressures across thewith political and financial pressures across the
nation.nation.
These recommendations wereThese recommendations were
(1) More and better research into mental health(1) More and better research into mental health
phenomena;phenomena;
(2) A broadened definition of who may provide(2) A broadened definition of who may provide
mental healthmental health
20. (3) That mental health services should be made(3) That mental health services should be made
available in the community;available in the community;
(4) That an awareness should be fostered that mental(4) That an awareness should be fostered that mental
illness can stem from social factors (such as ostracismillness can stem from social factors (such as ostracism
and isolation); andand isolation); and
(5) That the federal government should support these(5) That the federal government should support these
recommendations financially.recommendations financially.
In 1963, federal funds were provided to help in theIn 1963, federal funds were provided to help in the
construction and staffing of comprehensive mentalconstruction and staffing of comprehensive mental
health centers.health centers.
To qualify for these funds,To qualify for these funds, aa community mental healthcommunity mental health
centercenter had to provide five essential services:had to provide five essential services:
(1) Inpatient care;(1) Inpatient care;
(2) Outpatient care;(2) Outpatient care;
(3) Partial hospitalization (for example, the patient works(3) Partial hospitalization (for example, the patient works
during the day but returns to the hospital at night);during the day but returns to the hospital at night);
21. (4) Round-the-clock emergency service; and(4) Round-the-clock emergency service; and
(5) Consultation services to a variety of(5) Consultation services to a variety of
professional, educational, and serviceprofessional, educational, and service
personnel in the community.personnel in the community.
Beyond these required services, it was hopedBeyond these required services, it was hoped
that the mental health centers would alsothat the mental health centers would also
provideprovide
(1) Diagnostic services,(1) Diagnostic services,
(2) Rehabilitation services,(2) Rehabilitation services,
(3) Research,(3) Research,
(4) Training, and(4) Training, and
(5) Evaluation.(5) Evaluation.
22. THE CONCEPT OF PREVENTIONTHE CONCEPT OF PREVENTION
The idea ofThe idea of preventionprevention is the guiding principle that hasis the guiding principle that has
long been at the heart of public health programs in thelong been at the heart of public health programs in the
U.S.U.S.
Basically, the principle asserts that, in the long run,Basically, the principle asserts that, in the long run,
preventive activities will be more efficient and effectivepreventive activities will be more efficient and effective
than individual treatment administered after the onsetthan individual treatment administered after the onset
of diseases or problems .of diseases or problems .
That such approaches can work is graphicallyThat such approaches can work is graphically
illustrated by Price, Cowen, Lorion, and Ramos-illustrated by Price, Cowen, Lorion, and Ramos-
McKay (1988).McKay (1988).
Their book,Their book, FourteenFourteen OuncesOunces of Preventionof Prevention,,
describes 14 model prevention programs for children,describes 14 model prevention programs for children,
adolescents, or adults.adolescents, or adults.
Prevention programs for adults have been developedPrevention programs for adults have been developed
and implemented as well.and implemented as well.
23. PRIMARY PREVENTIONPRIMARY PREVENTION
This type of prevention represents the most radical departureThis type of prevention represents the most radical departure
from the traditionalfrom the traditional waysways of coping with mental health problems.of coping with mental health problems.
The essence of the notion-ofThe essence of the notion-of primary prevention can beprimary prevention can be seen inseen in
Caplan's (1964) emphasis on "counteracting harmfulCaplan's (1964) emphasis on "counteracting harmful
circumstances before they have had a chance to producecircumstances before they have had a chance to produce
illness".illness".
Albee (1986) points out, however, that the complexity of humanAlbee (1986) points out, however, that the complexity of human
problems often requires preventive strategies that depend onproblems often requires preventive strategies that depend on
social change and redistribution of power.social change and redistribution of power.
For many in society, this is not a highly palatable prospect.For many in society, this is not a highly palatable prospect.
Some examples of primary prevention include programs toSome examples of primary prevention include programs to
reduce job discrimination, enhance school curricula, improvereduce job discrimination, enhance school curricula, improve
housing, teach parenting skills, and provide help to childrenhousing, teach parenting skills, and provide help to children
from single-parent homes.from single-parent homes.
Also grouped under this heading are genetic counseling, HeadAlso grouped under this heading are genetic counseling, Head
Start, prenatal care for disadvantaged women, Meals onStart, prenatal care for disadvantaged women, Meals on
Wheels, and school lunch programs.Wheels, and school lunch programs.
24. SECONDARY PREVENTIONSECONDARY PREVENTION
This involves programs that promote the earlyThis involves programs that promote the early
identification of mental health problems and promptidentification of mental health problems and prompt
treatment of problems at an early stage so that mentaltreatment of problems at an early stage so that mental
disorders do not develop.disorders do not develop.
The basic idea ofThe basic idea of secondary preventionsecondary prevention is to attackis to attack
problems while they are still manageable, before theyproblems while they are still manageable, before they
become resistant to intervention.become resistant to intervention.
Often this approach suggests the screening of largeOften this approach suggests the screening of large
numbers of people. Such screening may be carried out bynumbers of people. Such screening may be carried out by
a variety of community service personnel.a variety of community service personnel.
Early assessment is followed, of course, by appropriateEarly assessment is followed, of course, by appropriate
referrals.referrals.
An example of secondary prevention is the early detectionAn example of secondary prevention is the early detection
and treatment of those individuals with potentiallyand treatment of those individuals with potentially
damaging drinking problemsdamaging drinking problems
A further example is the Rochester Primary Mental HealthA further example is the Rochester Primary Mental Health
Project pioneered by Emory Cowen.Project pioneered by Emory Cowen.
25. TERTIARY PREVENTIONTERTIARY PREVENTION
The goal ofThe goal of tertiary prevention istertiary prevention is to reduce the durationto reduce the duration
and the negative effects of mental disorders after theirand the negative effects of mental disorders after their
occurrence.occurrence.
Its aim is not to reduce the rate of new cases of mentalIts aim is not to reduce the rate of new cases of mental
disorder, but to lessen the effects of mental disorder oncedisorder, but to lessen the effects of mental disorder once
diagnosed.diagnosed.
A major focus of many tertiary programs is rehabilitation.A major focus of many tertiary programs is rehabilitation.
The methods used may be counseling, job training, andThe methods used may be counseling, job training, and
the like.the like.
Although their language is a bit different, tertiaryAlthough their language is a bit different, tertiary
preventive programs are not very different from personpreventive programs are not very different from person
oriented programs based on a deficit philosophy.oriented programs based on a deficit philosophy.
However, it is important to remember that all forms ofHowever, it is important to remember that all forms of
prevention are distinguished by their attempts to reduceprevention are distinguished by their attempts to reduce
the rates of, or problems associated with, mental disorderthe rates of, or problems associated with, mental disorder
on a community-wide (or population-wide) basis.on a community-wide (or population-wide) basis.